Rotator Cuff Injuries - Doing the Macarena Dance

The other day at dinner, while we were seated at the dining table, my wife suddenly turns to me and goes, “eh, you got so many aunts with shoulder pain, why don’t you write something about it?”. I looked at her, nodded and continued to gobble up my dinner.

She was right though you know. As I looked back, I recall having done many such “consultations” for family members. So why not, lets discuss why is it that shoulder pain is such a problem, especially amongst the ladies in the “golden age group”.  

There are many structures around the shoulder that could be a potential pain generator. Chief among the culprits that cause patients’ ailing are the rotator cuff tendons. They are a group of tendons, four to be exact, namely the supraspinatus, infraspinatus, subscapularis and the teres minor. These muscles/tendons are responsible for various types of movements of the shoulder joint, thus when they become injured, movement of the shoulder is also limited. There are certain limitations in activities that patients often complain about like; difficulty combing hair, reaching out for objects in high places and for ladies, hooking on or off their undergarments.

Each muscle/tendon are responsible for a certain type of shoulder motion, so to try and elicit which tendon it is that is causing the pain, your doctor will have to perform a physical examination. He/she might ask you to move your shoulder in various ways, and at times, it might almost seem like you are doing the Macarena dance during one of this examination.

These “injuries” to the tendons are usually not caused by a single event or trauma. Rather, they are described a spectrum of disease, whereby one thing leads to another which leads to another and so forth. Often times, there is degeneration and inflammation of the tendon which leads to them being worn down to a point that they eventually tear. This tear can be partial tear or a complete tear. Another way how these tendons get injured is when they come into contact with the bone overlying them. The friction between the tendon and the bone causes pain and wears down the tendon. This condition is specifically known as impingement syndrome, where the tendons are impinged by the acromion bone.

If this condition is left untreated and unchecked, it can lead to further destruction within the shoulder joint. Because the rotator cuff tendons/muscles are not functioning like they are supposed to, the stability of the shoulder joint is also affected. This is because this joint is an inherently unstable one. Being a “ball and socket” type of joint, its often described that stabalising the head of the humerus (the ball) on the glenoid (the socket) is like a seal balancing a ball on its nose or a golf ball balancing itself on a tee. Because of how unstable it is, the muscles and tendons play a very important role in maintaining a balance. Medically, this balancing act of the shoulder is called muscle patterning.

So, what happens when there is loss of said muscle balance? Because the humerus head is now not articulating or gliding how it’s supposed to against the glenoid, it predisposes the shoulder joint to developing arthritis. This is why, this condition is called a spectrum of diseases. What may have seemed like a benign inflammation of the tendon initially, has led to it being torn. This in turn has led to a loss of balancing within the joint and has finally resulted is osteoarthritis of the shoulder.

As in any other medical condition, history and examination play the biggest role in diagnosis. However, to confirm it, your doctor might order an ultrasound or MRI scan. These scans will be able to show the presence of tears, the size of the tears and if there’s any muscle atrophy that might have occurred as a result of prolonged misuse. All of this information play an integral part in decision making in terms of treatment plans.

So how do we treat this? For small tears, treatment will usually be focused more on physiotherapy for pain control, muscle strengthening and range of motion exercises. Steroid injection into the shoulder joint also plays a big role in relieving pain symptoms of those with impingement of the tendon. However, in cases of where the tear is large, one might need to go under the knife. The repair is usually done via a “keyhole surgery”, whereby specialised sutures called anchor sutures are used to secure these torn tendons. In the final step of the disease, when arthritis has set in, a joint replacement surgery might be indicated.

The shoulder joint plays a big role in all our daily activities, owning much to its ability to provide a huge range in motion. These movements are well illustrated in the Macarena dance. So, for you to continue doing the dance at the next big wedding event or dance festival, you would be well advised to look after that shoulder of yours.